Cargando…

Clinical potential of naloxegol in the management of opioid-induced bowel dysfunction

Opioid-induced bowel dysfunction (OIBD) is a burdensome condition which limits the therapeutic benefit of analgesia. It affects the entire gastrointestinal tract, predominantly by activating opioid receptors in the enteric nervous system, resulting in a wide range of symptoms, such as reflux, bloati...

Descripción completa

Detalles Bibliográficos
Autores principales: Poulsen, Jakob Lykke, Brock, Christina, Olesen, Anne Estrup, Nilsson, Matias, Drewes, Asbjørn Mohr
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179399/
https://www.ncbi.nlm.nih.gov/pubmed/25278772
http://dx.doi.org/10.2147/CEG.S52097
_version_ 1782337078743269376
author Poulsen, Jakob Lykke
Brock, Christina
Olesen, Anne Estrup
Nilsson, Matias
Drewes, Asbjørn Mohr
author_facet Poulsen, Jakob Lykke
Brock, Christina
Olesen, Anne Estrup
Nilsson, Matias
Drewes, Asbjørn Mohr
author_sort Poulsen, Jakob Lykke
collection PubMed
description Opioid-induced bowel dysfunction (OIBD) is a burdensome condition which limits the therapeutic benefit of analgesia. It affects the entire gastrointestinal tract, predominantly by activating opioid receptors in the enteric nervous system, resulting in a wide range of symptoms, such as reflux, bloating, abdominal cramping, hard, dry stools, and incomplete evacuation. The majority of studies evaluating OIBD focus on constipation experienced in approximately 60% of patients. Nevertheless, other presentations of OIBD seem to be equally frequent. Furthermore, laxative treatment is often insufficient, which in many patients results in decreased quality of life and discontinuation of opioid treatment. Novel mechanism-based pharmacological approaches targeting the gastrointestinal opioid receptors have been marketed recently and even more are in the pipeline. One strategy is prolonged release formulation of the opioid antagonist naloxone (which has limited systemic absorption) and oxycodone in a combined tablet. Another approach is peripherally acting, μ-opioid receptor antagonists (PAMORAs) that selectively target μ-opioid receptors in the gastrointestinal tract. However, in Europe the only PAMORA approved for OIBD is the subcutaneously administered methylnaltrexone. Alvimopan is an oral PAMORA, but only approved in the US for postoperative ileus in hospitalized patients. Finally, naloxegol is a novel, oral PAMORA expected to be approved soon. In this review, the prevalence and pathophysiology of OIBD is presented. As PAMORAs seem to be a promising approach, their potential effect is reviewed with special focus on naloxegol’s pharmacological properties, data on safety, efficacy, and patient-focused perspectives. In conclusion, as naloxegol is administered orally once daily, has proven efficacious compared to placebo, has an acceptable safety profile, and can be used as add-on to existing pain treatment, it is a welcoming addition to the targeted treatment possibilities for OIBD.
format Online
Article
Text
id pubmed-4179399
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher Dove Medical Press
record_format MEDLINE/PubMed
spelling pubmed-41793992014-10-02 Clinical potential of naloxegol in the management of opioid-induced bowel dysfunction Poulsen, Jakob Lykke Brock, Christina Olesen, Anne Estrup Nilsson, Matias Drewes, Asbjørn Mohr Clin Exp Gastroenterol Review Opioid-induced bowel dysfunction (OIBD) is a burdensome condition which limits the therapeutic benefit of analgesia. It affects the entire gastrointestinal tract, predominantly by activating opioid receptors in the enteric nervous system, resulting in a wide range of symptoms, such as reflux, bloating, abdominal cramping, hard, dry stools, and incomplete evacuation. The majority of studies evaluating OIBD focus on constipation experienced in approximately 60% of patients. Nevertheless, other presentations of OIBD seem to be equally frequent. Furthermore, laxative treatment is often insufficient, which in many patients results in decreased quality of life and discontinuation of opioid treatment. Novel mechanism-based pharmacological approaches targeting the gastrointestinal opioid receptors have been marketed recently and even more are in the pipeline. One strategy is prolonged release formulation of the opioid antagonist naloxone (which has limited systemic absorption) and oxycodone in a combined tablet. Another approach is peripherally acting, μ-opioid receptor antagonists (PAMORAs) that selectively target μ-opioid receptors in the gastrointestinal tract. However, in Europe the only PAMORA approved for OIBD is the subcutaneously administered methylnaltrexone. Alvimopan is an oral PAMORA, but only approved in the US for postoperative ileus in hospitalized patients. Finally, naloxegol is a novel, oral PAMORA expected to be approved soon. In this review, the prevalence and pathophysiology of OIBD is presented. As PAMORAs seem to be a promising approach, their potential effect is reviewed with special focus on naloxegol’s pharmacological properties, data on safety, efficacy, and patient-focused perspectives. In conclusion, as naloxegol is administered orally once daily, has proven efficacious compared to placebo, has an acceptable safety profile, and can be used as add-on to existing pain treatment, it is a welcoming addition to the targeted treatment possibilities for OIBD. Dove Medical Press 2014-09-19 /pmc/articles/PMC4179399/ /pubmed/25278772 http://dx.doi.org/10.2147/CEG.S52097 Text en © 2014 Poulsen et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Review
Poulsen, Jakob Lykke
Brock, Christina
Olesen, Anne Estrup
Nilsson, Matias
Drewes, Asbjørn Mohr
Clinical potential of naloxegol in the management of opioid-induced bowel dysfunction
title Clinical potential of naloxegol in the management of opioid-induced bowel dysfunction
title_full Clinical potential of naloxegol in the management of opioid-induced bowel dysfunction
title_fullStr Clinical potential of naloxegol in the management of opioid-induced bowel dysfunction
title_full_unstemmed Clinical potential of naloxegol in the management of opioid-induced bowel dysfunction
title_short Clinical potential of naloxegol in the management of opioid-induced bowel dysfunction
title_sort clinical potential of naloxegol in the management of opioid-induced bowel dysfunction
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179399/
https://www.ncbi.nlm.nih.gov/pubmed/25278772
http://dx.doi.org/10.2147/CEG.S52097
work_keys_str_mv AT poulsenjakoblykke clinicalpotentialofnaloxegolinthemanagementofopioidinducedboweldysfunction
AT brockchristina clinicalpotentialofnaloxegolinthemanagementofopioidinducedboweldysfunction
AT olesenanneestrup clinicalpotentialofnaloxegolinthemanagementofopioidinducedboweldysfunction
AT nilssonmatias clinicalpotentialofnaloxegolinthemanagementofopioidinducedboweldysfunction
AT drewesasbjørnmohr clinicalpotentialofnaloxegolinthemanagementofopioidinducedboweldysfunction